Together with traditional measures like smoking cessation aids, medications and surgeries, the updated recommendations can help people substantially reduce the risk of stroke, said Dr. James Meschia, who led the group that wrote the new guildelines for the American Heart Association/American Stroke Association.

"(Stroke is) not like one of those many conditions we have that there is no way to prevent it," Meschia told Reuters Health by phone.

About 796,000 U.S. adults have a stroke each year, the group writes in the journal Stroke. More than three quarters of these are first-time strokes.

The most common form of stroke occurs when blood flow is blocked in part of the brain, usually by a clot. Another form happens when a blood vessel breaks, haemorrhaging blood into the brain.

Preventing strokes

In the United States strokes are the fourth leading cause of death. People who do not die from strokes may be left immobile and dependant on others for care.

"Clearly treating stroke is very difficult," said Dr. Gregory Albers. "If you can prevent the stroke, it's much better," added Albers, who was not part of the guidelines group but directs the Stanford Stroke Center in California.

A 2010 study found that 90 percent of stroke risk is tied to risk factors, such as high blood pressure, excess body weight and smoking. While controlling those factors won't eliminate stroke risk, it can substantially reduce it, said Meschia, who is also chair of neurology at the Mayo Clinic in Jacksonville, Florida.

The guidelines, which were last updated in 2011, focus on what can be done to prevent a first-time stroke.

"Some of it isn't as new because it's pulling together guidelines from other areas," said Dr. Andrew Russman, who also wasn't involved in updating the guidelines but is a stroke expert from the Cleveland Clinic in Ohio.

For example, the new guidelines recommend use of an online tool that estimates a person's risk of stroke over the next 10 years based on race, gender, age, cholesterol, blood pressure, diabetes and smoking. (More information is available here: http://bit.ly/1uGpcMK.)

The guidelines also advise that people cut back on sodium and consume more potassium to lower blood pressure, and they recommend either a Dietary Approaches to Stop Hypertension (DASH) diet or a Mediterranean-style diet.

Mediterranean-style diets include a lot of fruit, vegetables and whole grains as well as fish, olive oil and nuts, but limit unhealthy fats. Mediterranean-style eating has been linked to lower risks of heart disease - possibly through reduced blood pressure.

"Clearly blood pressure - for stroke - is the number one risk factor," Albers said. "A lot of the stroke specialists like to see blood pressure down to 120 over 80."

Meschia agreed and said the new guidelines also recommend that people monitor their own blood pressure - not just wait for it to be measured at the doctor's office.

"If you had to do one thing and do one thing only, it's know your pressure and keep it down," he said.

Russman said the risk factors addressed by the new guidelines are important and controlling them early enough may prevent strokes.

"I think it stressed the importance of eating a healthy diet - like a Mediterranean diet - and the benefit of regular exercise and follow up with a primary care physician to identify problems early when they arise, so we can initiate lifestyle and medication interventions early to prevent future problems," Russman said.

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